Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Hypertension Reports
Published in: Current Hypertension Reports 2/2010

01-04-2010

The Obesity Paradox and Cardiovascular Disease

Authors: Stephen A. Morse, Rajat Gulati, Efrain Reisin

Published in: Current Hypertension Reports | Issue 2/2010

Login to get access

Abstract

Obesity is increasingly recognized as a global pandemic that threatens the health of millions of people. Obesity is considered to be an important cardiovascular risk factor, but there is increasing evidence that patients with elevated body mass index may be better off than others if they develop cardiovascular or renal disease. This phenomenon has been described as the "obesity paradox" or "reverse epidemiology." This article reviews some recent publications that have studied this phenomenon as it relates to heart failure, coronary artery disease, peripheral arterial disease, kidney disease, and a cohort of patients undergoing nonbariatric surgery.
Literature
1.
Lavie CJ, Milani R, Ventura HO: Obesity and cardiovascular disease. J Am Coll Cardiol 2009, 53:1925–1932.CrossRefPubMed
2.
Gregg EW, Cheng YJ, Cadwell BL, et al.: Secular trends in cardiovascular disease risk factors according to body mass index in US adults. JAMA 2005, 293:1868–1874.CrossRefPubMed
3.
Ford ES, Ajani UA, Croft JB, et al.: Explaining the decrease in US deaths from coronary disease, 1980–2000. N Engl J Med 2007, 356:2388–2398.CrossRefPubMed
4.
Habbu A, Lakkis NM, Dokainish H: The obesity paradox: fact or fiction? Am J Cardiol 2005, 98:944–948.CrossRef
5.
•• Fonarow GC, Srikanthan P, Costanzo MR, et al.: An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 109927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J 2007, 153:74–81. This study is significant in that it addresses the issue of inadequate numbers (power), with nearly 110,000 subjects enrolled in the study. It is significant in addressing the issue of whether BMI influences the mortality risk of acutely decompensated, hospitalized heart failure patients. The study found that there is an inverse relationship between mortality and BMI and that patients with higher BMI had lower inhospital mortality risk.CrossRefPubMed
6.
Oreopoulos A, Padwal R, Kalantar-zadeh K, et al.: Body mass index and mortality in heart failure: a meta-analysis. Am Heart J 2008, 156:13–22.CrossRefPubMed
7.
Arena R, Myers J, Abella J, et al.: Influence of etiology of heart failure on the obesity paradox. Am J Cardiol 2009, 104:1116–1121.CrossRefPubMed
8.
•• Uretsky S, Messerli FH, Bangalore S, et al.: Obesity paradox in patients with hypertension and coronary artery disease. Am J Med 2007, 120:863–870. This retrospective study is significant in that it addresses the question of the obesity paradox in patients with hypertension and CAD. The study looked at over 22,000 patients and found that there was a protective effect of elevated BMI in patients with CAD and hypertension. There is a need for well-powered, long-term prospective studies that look at the issue of “reverse epidemiology.” CrossRefPubMed
9.
Lavie CJ, Milani RV, Ventura HO: Obesity, heart disease, and favorable prognosis: truth or paradox? Am J Med 2007, 120:825–826.CrossRefPubMed
10.
Kalantar-Zadeh K, Kopple JD, Kilpatrick RD, et al.: Association of morbid obesity and weight change over time with cardiovascular survival in hemodialysis population. Am J Kidney Dis 2005, 46:489–500.CrossRefPubMed
11.
Lea JP, Crenshaw DO, Onufrak SJ, et al.: Obesity, end-stage renal disease, and survival in an elderly cohort with cardiovascular disease. Obesity 2009, 17(12):2216–2222.CrossRefPubMed
12.
Galal W, van Gestel YR, Hoeks SE, et al.: The obesity paradox in patients with peripheral arterial disease. Chest 2008, 134(5):925–930CrossRefPubMed
13.
•• Strandberg TE, Strandberg AY, Salomaa VV, et al.: Explaining the obesity paradox: cardiovascular risk, weigh change, and mortality during long-term follow-up in men. Eur Heart J 2009, 30(14):1720–1727. The aim of this study was to look at cardiovascular morbidity and mortality compared with the trajectory of weight gain and loss over the lifetime of the participants in a cohort of the Helsinki Businessmen Study, in which BMI and CVD risk factor data were acquired from 1974 to the present. It is a small study but it has shed some light on differences and on the significance of weight gain and loss during midlife and late life. CrossRefPubMed
14.
Hastie CE, Padmanabhan S, Slack R, et al.: Obesity paradox in a cohort of 4880 consecutive patients undergoing percutaneous coronary intervention. Eur Heart J 2010, 31(2):222–226.CrossRefPubMed
15.
Diercks D, Roe MT, Mulgund J, et al.: The obesity paradox in non-ST-segment elevation acute coronary syndromes: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative. Am Heart J 2006, 152(1):140–148.CrossRefPubMed
16.
•• Lavie CJ, Milani RV, Artham SM, et al.: The obesity paradox, weight loss and coronary disease. Am J Med 2009,122(12):1106–1114. The authors of this study have published extensively on the issue of the obesity paradox and present a small study consisting of 529 participants. The study is significant in that it addresses the question of weight loss or purposeful weight loss in cardiac patients undergoing rehabilitation and exercise training (CRET). Their findings that purposeful weight loss is associated with a trend towards lower mortality and improvement in CVD indices and quality of life is significant and will need to be addressed in larger, well-powered studies in different cohorts. CrossRefPubMed
17.
18.
•• Prospective Studies Collaboration, Whitlock G, Lewington S, et al.: Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet 2009, 373:1083–1096. This collaborative study is certainly well powered and addresses the issue of BMI and cause-specific mortality. It is significant in that it clearly associates increased morbidity and mortality with increased increments of BMI and confirms the classic understanding of the risks of increased weight.CrossRefPubMed
19.
Thomas F, Bean K, Pannier B, et al.: Cardiovascular mortality in overweight subjects: the key role of associated risk factors. Hypertension 2005, 46:654–659.CrossRefPubMed
20.
Metadata
Title
The Obesity Paradox and Cardiovascular Disease
Authors
Stephen A. Morse
Rajat Gulati
Efrain Reisin
Publication date
01-04-2010
Publisher
Current Science Inc.
Published in
Current Hypertension Reports / Issue 2/2010
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-010-0099-1

Other articles of this Issue 2/2010

Current Hypertension Reports 2/2010 Go to the issue

ReviewPaper

Oxidative Stress and Hypertension: Current Concepts

ReviewPaper

Central Adiposity, Systemic Inflammation, and the Metabolic Syndrome

OriginalPaper

Sodium Sensitivity of Blood Pressure in Chinese Populations

Clinical Trial Report

INVESTing in Hypertension

OriginalPaper

Carotid Baroreflex Activation: Past, Present, and Future

ReviewPaper

Modulation of Pressure-Natriuresis by Renal Medullary Reactive Oxygen Species and Nitric Oxide
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits